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(klor-DIE-aze-ee-POX-ide)
Libritabs, Librium, Mitran, Reposans-10,  Solium
Class: Antianxiety/benzodiazepine

 Action Potentiates action of GABA to produce CNS depression.

 Indications Management of anxiety disorders; relief of acute alcohol withdrawal symptoms; relief of preoperative apprehension and anxiety. Unlabeled use(s): Treatment of irritable bowel syndrome.

 Contraindications Hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; shock; coma; acute alcohol intoxication.

 Route/Dosage

Individualize dosage. Acute symptoms may be rapidly controlled IM or IV, with subsequent oral treatment (maximum 300 mg/day).

Mild-to-Moderate Anxiety

ADULTS: PO 5–10 mg tid or qid.

Severe Anxiety

ADULTS: PO 20–25 mg tid or qid. Initial dose: IM/IV 50–100 mg, then 25–50 mg tid or qid. ELDERLY OR DEBILITATED PATIENTS: PO 5 mg bid to qid. IM/IV 25–50 mg.

Preoperative Apprehension/Anxiety

ADULTS: PO 5–10 mg tid or qid on days preceding surgery. IM 50–100 mg 1 hr prior to surgery.

Acute Alcohol Withdrawal

ADULTS: IM/IV 50–100 mg; repeat q 2–4 hr prn. PO 50–100 mg, repeat prn (maximum oral or parenteral dose is 300 mg/day). CHILDREN (> 6 YR): PO 5–10 mg bid-qid; may be increased to 10 mg bid-tid. CHILDREN (> 12 YR): IM 0.5 mg/kg/day 6–8 hr.

 Interactions

Alcohol and CNS depressants: Additive CNS depressant effects are possible. Cigarette smoking, theophyllines: May antagonize sedative effects. Cimetidine, oral contraceptives, disulfiram, omeprazole: May increase effects of chlordiazepoxide with excessive sedation and impaired psychomotor function. Digoxin: May increase serum digoxin concentrations.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Cardiovascular collapse; hypotension; hypertension; tachycardia; bradycardia; edema; phlebitis or thrombosis at IV sites. CNS: Drowsiness; confusion; ataxia; dizziness; fatigue; apathy; memory impairment; disorientation; anterograde amnesia; restlessness; headache; slurred speech; loss of voice; stupor; coma; euphoria; irritability; vivid dreams; psychomotor retardation; paradoxical reactions (eg, anger, hostility, mania, insomnia, muscle spasms). DERM: Rash. EENT: Visual or auditory disturbances; depressed hearing. GI: Constipation; diarrhea; dry mouth; coated tongue; nausea; anorexia; vomiting. HEMA: Blood dyscrasias including agranulocytosis; anemia; thrombocytopenia; leukopenia; neutropenia. HEPA: Abnormal liver function tests; hepatic dysfunction including hepatitis and jaundice. OTHER: Dependency/withdrawal syndrome.

 Precautions

Pregnancy: Category D. Avoid especially in first trimester due to possible increased risk of congenital malformations. Lactation: Excreted in breast milk. Children: Initial dose should be small and gradually increased. Oral form not recommended in children < 6 yr; parenteral form not recommended in children < 12 yr. Elderly or debilitated patients: Initial dose should be small and gradually increased. Use with caution in patients with limited pulmonary reserve. Dependency: Prolonged use can lead to dependency. Withdrawal syndrome has occurred within 4–6 wk of treatment, especially if drug is abruptly discontinued. For discontinuation after long-term treatment, use caution and taper dosage. Psychiatric disorders: Not intended for patients with primary depressive disorder, psychosis or disorders in which anxiety is not prominent. Parenteral administration: Reserved primarily for acute states. Renal or hepatic impairment: Observe caution to avoid accumulation of drug. Suicide: Use with caution in patients with suicidal tendencies; do not allow patient access to large quantities of drug.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Give oral form with food or milk to decrease GI irritation.
  • Do not open capsules.
  • Use parenteral solutions immediately after reconstitution. Discard unused portion.
  • For intramuscular administration, reconstitute with diluent provided. Do not use diluent if opalescent or hazy. Agitate gently until dissolved. Give injection slowly deep in upper quadrant of gluteus maximus muscle.
  • For intravenous administration, reconstitute with 5 ml sterile physiologic saline or Sterile Water for Injection. Do not use diluent for intramuscular form. Administer injection slowly over 1 min.
  • Do not inject intra-arterially; intra-arterial injection may produce anteriospasm that can lead to gangrene.
  • Keep powder form away from light. Store in refrigerator until reconstitution.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Consider cross-sensitivity with other benzodiazepines.
  • Monitor BP, pulse rate and respiratory rate frequently when giving drug parenterally.
  • Assist with ambulation and use side-rails; drowsiness and orthostatic hypotension may occur early in therapy.
  • Monitor CBC; blood dyscrasias occur rarely with long-term use.
  • Monitor liver function during long-term therapy.
  • Assess for ataxia and oversedation in elderly, debilitated patient.
  • Monitor mental status: mood, sensorium, affect, sleep pattern, drowsiness, dizziness. Notify physician of mental status changes.
  • Observe patient closely for 3 hr following parenteral administration; bed rest is preferred. Do not permit patient to drive or perform other potentially hazardous tasks.
  • With treatment for alcohol withdrawal, assess for tremors, agitation, delirium and hallucinations.
  • Monitor for paradoxical reactions: excitement, stimulation, acute rage.
  • Restrict amount of medication available to patients with suicidal tendencies.
  • Observe for physical dependency/withdrawal symptoms with long-term use: headache, muscle pain, weakness, nausea, vomiting, increased anxiety.
  • Because of risk of apnea and cardiac arrest with parenteral administration, have resuscitative facilities available.
OVERDOSAGE: SIGNS & SYMPTOMS
  Drowsiness, confusion, somnolence, impaired coordination, diminished reflexes, lethargy, ataxia, hypotonia, hypotension, hypnosis, coma, death

 Patient/Family Education

  • Instruct patient to take drug with food or milk to prevent GI irritation.
  • Inform patient that drowsiness may be worse at beginning of therapy. Advise patient to use caution while driving or performing other tasks requiring mental alertness.
  • Instruct patient to rise slowly, especially if elderly, to avoid fainting.
  • Advise patient to report behavior changes, such as episodes of excitement, stimulation or acute rage, to physician.
  • Inform patient receiving long-term therapy or taking high doses that withdrawal symptoms may occur if drug is suddenly discontinued.
  • Advise patient to avoid intake of alcoholic beverages.
  • Caution patient not to take otc medications without consulting physician.

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